The healthcare industry is an attractive target for several reasons, each of which has some influence on the type of attacks they are susceptible to. Two of the most popular attack types on this industry are opportunistic attacks and targeted attacks, which we will be exploring throughout this blog.
An over-exposed threat surface and poor vulnerability management represents a weak security posture, which naturally increases an organization’s susceptibility to opportunistic threats. There are many tools available, both free through development platforms like Github and for sale in the underground markets, which can efficiently scan the internet for common vulnerabilities.
Vulnerabilities going back as far as 1999, such as CVE-1999-0517, are still regularly attempted by opportunistic threat actors. When a scanning tool detects exposed services and vulnerabilities, it flags the associated target. In this way, an attacker can whittle down the majority of cyberspace to a handful of vulnerable targets. In some cases, tools may even carry out exploits immediately after detecting the vulnerability.
Opportunistic attackers typically have financial incentives, as patient records average between $0.05 and $2.42 USD per record. Patient records are designated, under US law, as Protected Health Information (PHI) and can be used for various types of financial gain, including:
- For purchase on the Dark Web
- For insurance and tax fraud
- For blackmailing people whose public disclosure of illness could present PR problems
- For conducting spear-phishing campaigns against individuals whose records were compromised
eSentire’s Q3 Threat Report found OpenSSL’s Heartbleed (CVE-2014-0160) to be the most targeted vulnerability across all industries, followed by vulnerabilities in ASUS routers (CVE-2014-9583), Apache Struts (CVE-2017-5638), and Microsoft IIS (CVE-2000-0778, CVE-2000-0071, CVE-1999-1538). Similar vulnerabilities for the same software were found in externally-facing services among healthcare organizations, making them attractive targets for low-effort attacks. Most of these attacks require no action on the user’s part – attackers need only to find an exposed device through reconnaissance scans and run the exploit, often using the same tool that found the vulnerability in the first place.
The low security posture of most healthcare organizations may represent a target demographic for which these attacks are successful and, therefore, continue to persist years after patches have been released. Phishing attacks through email are also often opportunistic—malicious emails are sent to thousands of email addresses, which can be obtained from a curated list of potential victims.
Healthcare organizations, especially hospitals and clinics, are attractive targets for cybercriminals. The critical services they provide for patients places a hefty onus on decision-makers to consider extortion demands. For example, a well-known threat actor, “thedarkoverlord” targeted several healthcare organizations, publicly releasing password-protected dumps of sensitive healthcare information in an effort to scare the organizations into payment.
In addition to data theft and extortion, threat actors also know that hospitals are susceptible to PoS attacks, in which threat actors collect credit card information from connected PoS devices. This activity typically occurs in hospital cafeterias, where security is minimal  and monitoring and securing PoS devices used for retail is perceived as a low priority.
Furthermore, healthcare organizations are likely to be targeted by nation-state threat actors in the context of cyberwar. Disrupting medical services alongside utilities (like power and water) will lead to the disruption of political processes in the targeted country as emergency protocols take precedence. It is suspected that many recent cyberattacks on Ukraine’s infrastructure (including power, transportation, and medical organizations) serve as a training and testing exercise for a larger-scale global cyber-attack. If such an attack were to be launched against the healthcare system of North America in its current state, there would be little to stop it and no one to mitigate an incident response.
Figure 2: Targeted Vulnerabilities Across All Industries
Attacks observed on healthcare organizations across the eSentire client base show a large percentage of traffic is derived from reconnaissance activity, such as Network Scanner and SSH scans (shown in purple). The industry also experiences a high degree of Fraud in the form of phishing (green) and exploit attempts (yellow), presumably on a consumer-grade D-Link router.
Figure 3: Attack Types
The weak security posture of the healthcare industry is an escalating problem. The industry’s lack of cybersecurity awareness combined with steady advances in technology (such as IoT pacemakers, life monitors and prosthetics) will continue to expand the industry’s threat surface.
Healthcare organizations are hesitant to dedicate budget to cybersecurity, yet they continue to spend in other areas of Information Technology. This mindset will likely shift – sooner than later – and likely in response to a catastrophe rather than as a preventative measure. Organizations that aren’t prepared for the next big breach will have to allocate a larger share of funds to incident response, causing them to fall behind in the continuously evolving cyber-arms race. Organizations that take preventative measures, on the other hand, will avoid the costs (and risks to their patients) of a major breach and will be able to focus on maturing and developing cybersecurity standards that adapt to how threats continue to evolve in the wild.
 Healthcare Cybersecurity: Healthcare Today, Your Community Tomorrow, 2016
 Yasinsky, 2017